Accuracy of sperm–cervical mucus penetration tests in evaluating sperm motility in semen: a systematic quantitative review
TL;DR: This method of using sperm concentration, instead of vanguard distance, as diagnostic criteria of in-vitro SMPT has potential as a useful laboratory-based sperm function test.
Abstract: Background Our objective was to determine the accuracy of in-vitro sperm penetration into cervical mucus or substitutes in evaluating sperm motility in semen. Methods This was a systematic quantitative review of test accuracy studies. The Cochrane library (2000:4), Medline (1966-2001), Embase (1988-2001) and SciSearch (1981-2001) were searched, in addition to manual searches of conference papers and bibliographies of known primary and review articles. Primary studies measuring in-vitro sperm penetration into cervical mucus, or substitutes (i.e. sperm-mucus penetration test, SMPT) and comparing results with sperm motility in semen were included. Results There were 18 primary diagnostic studies published in 17 papers, involving a total of 2580 samples. Fourteen primary diagnostic tests used vanguard distance as diagnostic criteria (SMPT(vd)) and the pooled likelihood ratio (LR) for positive (LR+) and negative (LR-) tests were 2.29 (1.82-2.87) and 0.52 (0.44-0.63) respectively. Four studies used diagnostic criteria based directly or indirectly on swim-up sperm count per high power field (SMPT(sc)) instead. Their pooled LR+ and LR- were 5.24 (3.36-8.18) and 0.15 (0.06-0.39) respectively. Conclusions SMPT(vd) has a low accuracy in the evaluation of sperm motility in semen. However, SMPT(sc) was found to be more accurate. This method of using sperm concentration, instead of vanguard distance, as diagnostic criteria of in-vitro SMPT has potential as a useful laboratory-based sperm function test.
Citations
More filters
TL;DR: High frame rate digital imaging is used for the first time to characterise the flagellar movement of migrating sperm in low and high viscosities, and shows in precise spatial and temporal detail waveform evolution along theFlagellum.
Abstract: A pre-requisite for sexual reproduction is successful unification of the male and female gametes; in externally-fertilising echinoderms the male gamete is brought into close proximity to the female gamete through chemotaxis, the associated signalling and flagellar beat changes being elegantly characterised in several species. In the human, sperm traverse a relatively high-viscosity mucus coating the tract surfaces, there being a tantalising possible role for chemotaxis. To understand human sperm migration and guidance, studies must therefore employ similar viscous in vitro environments. High frame rate digital imaging is used for the first time to characterise the flagellar movement of migrating sperm in low and high viscosities. While qualitative features have been reported previously, we show in precise spatial and temporal detail waveform evolution along the flagellum. In low viscosity the flagellum continuously moves out of the focal plane, compromising the measurement of true curvature, nonetheless the presence of torsion can be inferred. In high viscosities curvature can be accurately determined and we show how waves propagate at approximately constant speed. Progressing waves increase in curvature approximately linearly except for a sharper increase over a distance approximately 20-27 microm from the head/midpiece junction. Curvature modulation, likely influenced by the outer dense fibres, creates the characteristic waveforms of high viscosity swimming, with remarkably effective cell progression against greatly increased resistance, even in high viscosity liquids. Assessment of motility in physiological viscosities will be essential in future basic research, studies of chemotaxis and novel diagnostics.
203 citations
Cites background from "Accuracy of sperm–cervical mucus pe..."
...…known as (modified) ‘Kremer penetration assays’ [Kremer, 1965; Katz et al., 1980; Mortimer et al., 1990; Aitken et al., 1992; Ivic et al., 2002; Ola et al., 2003] have examined the migrating subpopulation of cells, however available data have mainly concerned qualitative characterisations of…...
[...]
...Classic research on human sperm migrating in cervical mucus (or analogues), known as (modified) ‘Kremer penetration assays’ [Kremer, 1965; Katz et al., 1980; Mortimer et al., 1990; Aitken et al., 1992; Ivic et al., 2002; Ola et al., 2003] have examined the migrating subpopulation of cells, however available data have mainly concerned qualitative characterisations of the waveform [Katz et al....
[...]
TL;DR: The role that the viscosity of the mucous layers, which coat the entire tract and through which sperm must swim, plays in both sperm selection and ongoing modulation of their behaviour is neglected.
Abstract: The success of internal fertilization is reliant upon successful sperm migration through the female tract. Timely location of the oocyte in what is a complex three-dimensional, highly invaginated series of moist opposed surfaces is a challenge at which only tens of sperm ever succeed. In part this could be due to the differences in scale, with a 50 mm long cell facing a probable migration of well over 20 cm due to the complex architecture. Many groups have focused upon the role for a chemotactic 'attractive egg' effect in guiding sperm to increase numbers at the fertilization site. What most research has neglected to consider is the role that the viscosity of the mucous layers, which coat the entire tract and through which sperm must swim, plays in both sperm selection and ongoing modulation of their behaviour. From allow- ing sperm to enter through the cervix during the ovulation phase, to denying them entrance through action of the female contraceptive pill, viscous effects are fundamental in controlling the migrating sperm population throughout the tract. The physiological effects of viscosity are also crucial to consider when designing and extrapolating data from in vitro experiments to the in vivo situation.
102 citations
Cites methods from "Accuracy of sperm–cervical mucus pe..."
...…analogues has been identified as a more accurate predictor of fertility than the previous-used measure of ‘vanguard distance’, i.e. the maximum migration distance (see systematic review by Ola et al., 2003, also earlier papers by Mills and Katz, 1978; Mortimer et al., 1990; Aitken et al., 1992)....
[...]
TL;DR: This review focuses on recent studies that describe the relationships between the ultrastructural and rheological properties of bovine vaginal fluid and sperm motion and proposes bovines vaginal fluid as a morphofunctional model for the study of sperm transport in mammals.
Abstract: The tubular genital organs of the mammalian female reproductive tract provide different luminal microenvironments that can act as an aid or a barrier to gamete transport and the first steps of embryonic development. The mechanism of sperm transport through the genital tract has not been fully established but, first of all, sperm cells encounter and need to overcome mucous-like secretions to reach the site where fertilization occurs. One of these secretions, vaginal fluid, is a complex biological product, which is mainly derived from cervical mucus. In this review, we focus on recent studies that describe the relationships between the ultrastructural and rheological properties of bovine vaginal fluid and sperm motion. In the light of this, we propose bovine vaginal fluid as a morphofunctional model for the study of sperm transport in mammals.
78 citations
TL;DR: In this article, the authors compared the quality and sperm penetrability of mid-cycle cervical mucus between LNG-IUS users and hormone-free controls and found that 14% of IUS users had CMA score ≥ 10% vs. 69% of controls (p=.004).
63 citations
01 Mar 2012
TL;DR: The authors identified systematic reviews including quantitative synthesis (meta-analysis) of test accuracy for diagnostic or predictive medical tests through MEDLINE searches (1966 to December 2009) and perusal of reference lists of eligible articles and relevant reviews.
Abstract: Background Medical tests play a critical role in disease screening, diagnosis, and prediction of future outcomes. Meta-analyses of diagnostic or predictive test accuracy are increasingly performed and the relevant methods are continuously evolving. Methods We identified systematic reviews including quantitative synthesis (meta-analysis) of test accuracy for diagnostic or predictive medical tests through MEDLINE searches (1966 to December 2009) and perusal of reference lists of eligible articles and relevant reviews. We extracted information on topics and test types covered, methods for literature synthesis and quality assessment, availability of data, and statistical analyses performed. Results Our searches retrieved 1,225 potentially eligible reviews of which 760 (published from 1987 to 2009) were finally considered eligible for inclusion. Eligible reviews included a median of 18 primary studies and typically examined a single index test against a single reference standard. The number of publications increased per calendar year (P Conclusion Meta-analyses of diagnostic or predictive tests are increasingly performed. Over time there have been substantial improvements in the literature review, quality assessment and statistical analysis methods employed. Much of the improvement in quality assessment is associated with the use of quality item checklists. Advanced statistical methods have been increasingly adopted over time but their use still remains limited.
36 citations
References
More filters
TL;DR: A general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies is presented and tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interob server agreement are developed as generalized kappa-type statistics.
Abstract: This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
64,109 citations
"Accuracy of sperm–cervical mucus pe..." refers background in this paper
...Kappa statistics assess agreement beyond chance and allow credit for partial accord ( Landis and Koch, 1977 )....
[...]
TL;DR: Funnel plots, plots of the trials' effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials.
Abstract: Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews . Main outcome measure: Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision. Results: In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias. Conclusions: A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution. Key messages Systematic reviews of randomised trials are the best strategy for appraising evidence; however, the findings of some meta-analyses were later contradicted by large trials Funnel plots, plots of the trials9 effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials Funnel plot asymmetry was found in 38% of meta-analyses published in leading general medicine journals and in 13% of reviews from the Cochrane Database of Systematic Reviews Critical examination of systematic reviews for publication and related biases should be considered a routine procedure
37,989 citations
TL;DR: This paper examines eight published reviews each reporting results from several related trials in order to evaluate the efficacy of a certain treatment for a specified medical condition and suggests a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
33,234 citations
01 Jan 1980
TL;DR: This laboratory manual consists of 2 sections which describe methods of examination of human semen and semen-cervical mucus interaction in order to standardize procedures and facilitate evaluation and comparison of research reports.
Abstract: This laboratory manual consists of 2 sections which describe methods of examination of human semen and semen-cervical mucus interaction in order to standardize procedures and facilitate evaluation and comparison of research reports The section on semen collection and examination discusses and makes recommendations for sample collection and delivery; initial examination; motility assessment estimation of sperm density; examination of particulate debris; agglutination; sperm viability; counting the spermatozoa; and analysis of morphological characteristics of germinal cells including preparation of seminal fluid smears staining method and classification and quantification of germinal cells and leucocytes Photomicrographs are provided to demonstrate morphological characteristics of normal and abnormal mature sperm immature germinal cells and leucocytes and epithelial cells Appendices provide information on frequency of various sperm forms in a normal ejaculate Papanicolaou staining procedure for sperm and the Bryan/Leishman stain for seminal fluid morphology smears A sample record for sperm analysis is also included The section on sperm-cervical mucus interaction describes the composition and characteristics of the mucus the collection procedure storage and preservation and evaluation including pH Methods of evaluating sperm-cervical mucus interaction are then described The timing and techniques of the post-coital test vaginal pool sample exocervical and low cervical samples and endocervical samples and their interpretation are discussed Instructions are provided for in vitro studies including the capillary tube test and the slide technique
2,141 citations
TL;DR: These data provide empirical evidence that diagnostic studies with methodological shortcomings may overestimate the accuracy of a diagnostic test, particularly those including nonrepresentative patients or applying different reference standards.
Abstract: ContextThe literature contains a large number of potential biases in the evaluation
of diagnostic tests. Strict application of appropriate methodological criteria
would invalidate the clinical application of most study results.ObjectiveTo empirically determine the quantitative effect of study design shortcomings
on estimates of diagnostic accuracy.Design and SettingObservational study of the methodological features of 184 original studies
evaluating 218 diagnostic tests. Meta-analyses on diagnostic tests were identified
through a systematic search of the literature using MEDLINE, EMBASE, and DARE
databases and the Cochrane Library (1996-1997). Associations between study
characteristics and estimates of diagnostic accuracy were evaluated with a
regression model.Main Outcome MeasuresRelative diagnostic odds ratio (RDOR), which compared the diagnostic
odds ratios of studies of a given test that lacked a particular methodological
feature with those without the corresponding shortcomings in design.ResultsFifteen (6.8%) of 218 evaluations met all 8 criteria; 64 (30%) met 6
or more. Studies evaluating tests in a diseased population and a separate
control group overestimated the diagnostic performance compared with studies
that used a clinical population (RDOR, 3.0; 95% confidence interval [CI],
2.0-4.5). Studies in which different reference tests were used for positive
and negative results of the test under study overestimated the diagnostic
performance compared with studies using a single reference test for all patients
(RDOR, 2.2; 95% CI, 1.5-3.3). Diagnostic performance was also overestimated
when the reference test was interpreted with knowledge of the test result
(RDOR, 1.3; 95% CI, 1.0-1.9), when no criteria for the test were described
(RDOR, 1.7; 95% CI, 1.1-2.5), and when no description of the population under
study was provided (RDOR, 1.4; 95% CI, 1.1-1.7).ConclusionThese data provide empirical evidence that diagnostic studies with methodological
shortcomings may overestimate the accuracy of a diagnostic test, particularly
those including nonrepresentative patients or applying different reference
standards.
1,651 citations
"Accuracy of sperm–cervical mucus pe..." refers methods in this paper
...We considered a study to be of good quality if it used a prospective design, consecutive enrolment, adequate test description, and blinding of the test result ( Lijmer et al., 1999; Khan et al., 2001b)....
[...]